Vitamin D is the 3rd best predictor of bleeding after hemodialysis - Oct 2024

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Prediction of gastrointestinal bleeding hospitalization risk in hemodialysis using machine learning

BMC Nephrology volume 25, Article number: 366 (2024)
John W. Larkin, Suman Lama, Sheetal Chaudhuri, Joanna Willetts, Anke C. Winter, Yue Jiao, Manuela Stauss-Grabo, Len A. Usvyat, Jeffrey L. Hymes, Franklin W. Maddux, David C. Wheeler, Peter Stenvinkel & Jürgen Floege on behalf of the INSPIRE Core Group

Background
Gastrointestinal bleeding (GIB) is a clinical challenge in kidney failure. INSPIRE group assessed if machine learning could determine a hemodialysis (HD) patient’s 180-day GIB hospitalization risk.

Methods
An eXtreme Gradient Boosting (XGBoost) and logistic regression model were developed using an HD dataset in United States (2017–2020). Patient data was randomly split (50% training, 30% validation, and 20% testing). HD treatments ≤ 180 days before GIB hospitalization were classified as positive observations; others were negative. Models considered 1,303 exposures/covariates. Performance was measured using unseen testing data.

Results
Incidence of 180-day GIB hospitalization was 1.18% in HD population (n = 451,579), and 1.12% in testing dataset (n = 38,853). XGBoost showed area under the receiver operating curve (AUROC) = 0.74 (95% confidence interval (CI) 0.72, 0.76) versus logistic regression showed AUROC = 0.68 (95% CI 0.66, 0.71). Sensitivity and specificity were 65.3% (60.9, 69.7) and 68.0% (67.6, 68.5) for XGBoost versus 68.9% (64.7, 73.0) and 57.0% (56.5, 57.5) for logistic regression, respectively. Associations in exposures were consistent for many factors. Both models showed GIB hospitalization risk was associated with older age, disturbances in anemia/iron indices, recent all-cause hospitalizations, and bone mineral metabolism markers.
XGBoost showed high importance on outcome prediction for serum 25 hydroxy (25OH) vitamin D levels, while logistic regression showed high importance for parathyroid hormone (PTH) levels.

Conclusions
Machine learning can be considered for early detection of GIB event risk in HD. XGBoost outperforms logistic regression, yet both appear suitable. External and prospective validation of these models is needed. Association between bone mineral metabolism markers and GIB events was unexpected and warrants investigation.
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Bleeding Incidence 2-6% – clipped from PDF

Major bleeding events have about a 2% to 6% incidence per year in dialysis [5–7], which is more than sevenfold higher than the incidence rate in the general population [8]. Bleeding events difer by modality, with higher rates seen in hemodialysis (HD) versus peritoneal dialysis (PD) [9]. Most bleeding events are due to a gastrointestinal bleed (GIB), with about 20% requiring hospitalization [5, 10]. Incidence of GIB hospitalizations has been increasing over time in the dialysis population [10]. Dialysis patients who experienced a GIB have a 90% higher risk of death occurring any time after the event, a risk that increases with every GIB event [10].

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VitaminDWiki – Overview Kidney and vitamin D contains

• FACT: The Kidneys are not the primary way to activate vitamin D; the tissues are
• FACT: When the Kidney has problems, there is less active vitamin D (Calcitriol) for the body
• FACT: When the Kidney has problems, there is increased death due to many factors - many of which are associated with lack of Calcitriol
• FACT: There are many ongoing intervention clinical trials trying to determine how much of what kind of vitamin D is needed to treat the problem
• FACT: One Randomized Controlled Trial has proven that Vitamin D treats CKD
• FACT: 38% of seniors have Chronic Kidney Disease and most are unaware of it CDC statistics 2020
• FACT: Taking extra Vitamin D, in various forms, does not cause health problems - even if poor kidney
• Suggestion: Increase vitamin D getting into body now - and increase co-factors so that the vitamin D can be better used
    Sun, UV lamp, Vitamin D supplement - probably > 5,000 IU,
  Nanoemulstion vitamin D (inside cheek, topically) gets activated Vitamin D to the cells without the need for healthy kidney, liver, or intestine
  Calcitriol - which bypasses the need for the kidney to activate vitamin D
    Problems with Calcitriol however: typically only lasts for a few hours, also, possible complications
      Update: Pre-cursor of active vitamin D made from plants is better than calcitriol – Sept 2012
• Category Kidney and Vitamin D contains 235 items

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VitaminDWiki – Chronic Kidney Disease needs Vitamin D - many studies

Chronic Kidney Disease decreases Vitamin D level in 4 ways
4X more Chronic Kidney disease patients are now using vitamin D – March 2014
Vitamin D testers have different test results if there is chronic kidney disease – Sept 2019
Kidney dialysis often filters out vitamin D
Low vitamin D causes many health problems, such as weak bones
Want to have good Vitamin D levels to prevent CKD from causing other health problems
Higher vitamin D levels can treat CKD 50 ng   80 ng
Monthly dosing appears better than daily for CKD and many other health problems
CKD also decreases Vitamin K2-7
Form of vitamin D to be used; normal, Calcitriol, or synthetic
Non-oral form is often better for CKD ( topical, emulsion swished in mouth, patch cream, etc)

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VitaminDWiki – Suspect that non-oral vitamin D is best for CKD

Sun, UVB, Topical, Sublingual forms get vitamin D to the cells, bypassing the kidneys
Doubt that CKD doctors or hemodialysis clinics are aware of this

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Hemodialysis: 4 hours per session, 3 sessons per week, costs $80,000/year

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40+ VitaminDWiki pages with HEMODIALYSIS etc in title

This list is automatically updated